A review on ambulance offload delay literature

Li, Mengyu; Vanberkel, Peter T.; Carter, Alix

doi:10.1007/s10729-018-9450-x

Cited by 51 publications

(41 citation statements)

References 111 publications

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“…Our findings are similar to those of a multicentre Australian study, which reported that offload delays > 30 minutes led to other process delays but did not increase patient mortality. 10,16 They are also concordant with a case-control study showing that offload delays were associated with delayed triage (10 v. 4 minutes) and prolonged ED LOS, but not with in-hospital mortality. 16,17 The absence of any apparent harm signal in our data is counterintuitive, but there are several plausible explanations.…”

Section: Discussionsupporting

confidence: 81%

“…10,16 They are also concordant with a case-control study showing that offload delays were associated with delayed triage (10 v. 4 minutes) and prolonged ED LOS, but not with in-hospital mortality. 16,17 The absence of any apparent harm signal in our data is counterintuitive, but there are several plausible explanations. The first is that triage nurses are good at their job and able to select a lower-risk patient population for hallway placement when ED stretchers are blocked.…”

Section: Discussionsupporting

confidence: 81%

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Are emergency medical services offload delay patients at increased risk of adverse outcomes?

Stewart

Lang

Wang

et al. 2019

CJEM

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ObjectiveEmergency department (ED) and hospital overcrowding cause offload delays that remove emergency medical services (EMS) crews from service and compromise care delivery. Prolonged ED boarding and delays to inpatient care are associated with increased hospital length of stay (LOS) and patient mortality, but the effects of EMS offload delays have not been well studied.MethodsWe used administrative data to study all high-acuity Canadian Triage Acuity Scale 2–3 EMS arrivals to Calgary adult EDs from July 2013 to June 2016. Patients offloaded to a care space within 15 minutes were considered controls, whereas those delayed ≥ 60 minutes were considered “delayed.” Propensity matching was used to create comparable control and delayed cohorts. The primary outcome was 7-day mortality. Secondary outcomes included hospital LOS and 30-day mortality.ResultsOf 162,002 high-acuity arrivals, 70,711 had offload delays <15 minutes and 41,032 had delays > 60 minutes. Delayed patients were more likely to be female, older, to have lower triage acuity, to live in dependent living situations, and to arrive on weekdays and day or evening hours. Delayed patients less often required admission and, when admitted, were more likely to go to the hospitalist service. Main outcomes were similar for propensity-matched control and delayed cohorts, although delayed patients experienced longer ED LOS and slightly lower 7-day mortality rates.ConclusionIn this setting, high-acuity EMS arrivals exposed to offload delays did not have prolonged hospital LOS or higher mortality than comparable patients who received timely access.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 81%

Are emergency medical services offload delay patients at increased risk of adverse outcomes?

Stewart

Lang

Wang

et al. 2019

CJEM

View full text Add to dashboard Cite

show abstract

“…It is more helpful in cases of budget restrictions, because increasing the ED capacity requires a huge increase in the budget, owing to the addition of medical resources, such as beds and medical staff. Moreover, according to many previous studies, AD is the most common solution to reducing the ambulance offload delay, which is affected by ED congestion [ 13 ]. Many hospitals and EMS systems have implemented AD policies to reduce ED overcrowding [ 14 , 15 , 16 ].…”

Section: Literature Reviewmentioning

confidence: 99%

Centralized Ambulance Diversion Policy Using Rolling-Horizon Optimization Framework to Minimize Patient Tardiness

2020

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Ambulance diversion (AD) is a common method for reducing crowdedness of emergency departments by diverting ambulance-transported patients to a neighboring hospital. In a multi-hospital system, the AD of one hospital increases the neighboring hospital’s congestion. This should be carefully considered for minimizing patients’ tardiness in the entire multi-hospital system. Therefore, this paper proposes a centralized AD policy based on a rolling-horizon optimization framework. It is an iterative methodology for coping with uncertainty, which first solves the centralized optimization model formulated as a mixed-integer linear programming model at each discretized time, and then moves forward for the time interval reflecting the realized uncertainty. Furthermore, the decentralized optimization, decentralized priority, and No-AD models are presented for practical application, which can also show the impact of using the following three factors: centralization, mathematical model, and AD strategy. The numerical experiments conducted based on the historical data of Seoul, South Korea, for 2017, show that the centralized AD policy outperforms the other three policies by 30%, 37%, and 44%, respectively, and that all three factors contribute to reducing patients’ tardiness. The proposed policy yields an efficient centralized AD management strategy, which can improve the local healthcare system with active coordination between hospitals.

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“…The systemic review by Li and his friends 24 found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated.…”

Section: Comparison To Related Studiesmentioning

confidence: 99%

Understanding factors of ambulance delay and crash to enhance ambulance efficiency: an integrative literature review

Wiwekananda

Hamukti

Yogananda

et al. 2020

J Community Empowerment for Health

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Trauma is one of the major causes of deaths worldwide. The referral time of trauma patients to the trauma center is a vital determinant of traumatic injury patients’ survival. Ambulance delays and crashes are the major causes of delay of patient transportation to the hospital. This review was conducted to find the main factors that cause ambulance crashes and ambulance delays; and discuss the correlation of both factors. Hence, the authors might suggest an appropriate solution to minimize ambulance delay and crash incidents. This integrative literature review applied the PRISMA-P protocol to ensure a robust literature search. A total of nine databases and publishers (i.e., PubMed, Scopus, ScienceDirect, ASCE Library, Clinical Key, EBSCO, Cambridge, Taylor & Francis, and ProQuest) were searched using relevant keywords to obtain studies on ambulance delays and ambulance crashes. The literature search retrieved 620 studies to be screened based on the exclusion-inclusion criteria which finally resulted in the 12 studies included in the review. The researchers conducted a risk of bias assessment using Joanna Briggs Institute's critical appraisal tools. Data from the included studies were then extracted and analyzed using descriptive statistics to identify the factors affecting ambulance delays and crashes. After conducting an integrative literature review, the main factor that causes ambulance delays is traffic congestion. Meanwhile, the main factor causing ambulance crashes is intersection. Traffic congestion often occurs especially at intersections. The authors concluded that, intersections have a significant effect on ambulance delays and also ambulance crashes. To overcome this problem, the authors suggest to make an additional ambulance caution signal lamp on all congested intersections.

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A review on ambulance offload delay literature

Cited by 51 publications

References 111 publications

Are emergency medical services offload delay patients at increased risk of adverse outcomes?

Are emergency medical services offload delay patients at increased risk of adverse outcomes?

Centralized Ambulance Diversion Policy Using Rolling-Horizon Optimization Framework to Minimize Patient Tardiness

Understanding factors of ambulance delay and crash to enhance ambulance efficiency: an integrative literature review

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